Testicular tumour associated with hormonal treatment for oligospermia

Methyltertiary-Butyl Ether: Studies for Potential Human Health Hazards

When methyl tertiary-butyl ether (MTBE) in gasoline was first introduced to reduce vehicle exhaust emissions and comply with the Clean Air Act, in the United States, a pattern of complaints emerged characterised by seven "key symptoms." Later, carefully controlled volunteer studies did not confirm the existence of the specific key symptoms, although one study of self-reported sensitive (SRS) people did suggest that a threshold at about 11-15% MTBE in gasoline may exist for SRSs in total symptom scores. Neurobehavioral and psychophysiological studies on volunteers, including SRSs, found no adverse responses associated with MTBE at likely exposure levels. MTBE is well and rapidly absorbed following oral and inhalation exposures. Cmax values for MTBE are achieved almost immediately after oral dosing and within 2 h of continuous inhalation. It is rapidly eliminated, either by exhalation as unchanged MTBE or by urinary excretion of its less volatile metabolites. Metabolism is more rapid humans than in rats, for both MTBE and tert-butyl alcohol (TBA), its more persistent primary metabolite. The other primary metabolite, formaldehyde, is detoxified at a rate very much greater than its formation from MTBE. MTBE has no specific effects on reproduction or development, or on genetic material. Neurological effects were observed only at very high concentrations. In carcinogenicity studies of MTBE, TBA, and methanol (included as an endogenous precursor of formaldehyde, without the presence of TBA), some increases in tumor incidence have been observed, but consistency of outcome was lacking and even some degree of replication was observed in only three cases, none of which had human relevance: alpha(2u)-globulin nephropathy-related renal tubule cell adenoma in male rats; Leydig-cell adenoma in male rats, but not in mice, which provide the better model of the human disease; and B-cell-derived lymphoma/leukemia of doubtful pathogenesis that arose mainly in lungs of orally dosed female rats. In addition, hepatocellular adenomas were significantly higher in female CD-1 mice and thyroid follicular-cell adenomas were increased in female B6C3F1 mice treated with TBA, but these results lack any independent confirmation, which would have been possible from a number of other studies.

Incidence of testicular microlithiasis

In adults polytopic intratubular calcifications of the testes are rare. Known as testicular microlithiasis, they manifest themselves in a characteristic echo pattern on sonography with high-frequency transducers (5 to 10 MHz). This consists of multiple echogenic specks in an otherwise normal testicular parenchyma. In a retrospective analysis of 1,710 testicular sonograms of adults, bilateral intratesticular microliths were found in 11 cases (0.6%). In 5 of them, the microliths were associated with a testicular tumor. One patient with a tumor in the contralateral testis had undergone radiotherapy and another one presented with hypogonadism. Four patients with noncontributory histories presented with varicocele or epididymal cyst. Sonographic findings were confirmed histologically in 6 patients. Multiple intratubular calcifications were found in all of them. The pathogenesis of testicular microliths is still poorly understood. Their clinical relevance is unclear, but their incidence in adults appears to be higher than reported in the literature.

Testicular calcifications and neoplasia in patient treated for subfertility

A subfertile male with a history of left cryptorchism underwent scrotal ultrasound that revealed stippled calcifications, without associated mass, in the right testicle. Six months later, while on a regimen of clomiphene citrate, a testicular tumor became palpable. This was sonographically confirmed to be surrounding the calcifications. Testicular calcifications are most commonly associated with benign conditions. We review the literature regarding their relationship to neoplasms and the significance of the ultrasonic findings. Furthermore, this is the sixth reported case of testicular tumor developing during hormonal treatment for oligospermia. Although these cases may be circumstantial, closer surveillance and screening ultrasound may be indicated for subfertile males taking clomiphene citrate.

Recent developments in the toxicology of anabolic steroids

Anabolic steroids are extensively abused as ergogenic aids by athletes (and others). A number of features of anabolic steroid use and toxicology have been recently reviewed in the Journal, and a large body of data has accumulated concerning their toxic nature. The lipoprotein profile induced by anabolic steroids carries a markedly adverse cardiovascular risk. Glucose metabolism is significantly altered and includes peripheral insulin resistance, hyperinsulinaemia and attenuated responses to glucagon. Hypertension has been noted. Psychiatric and psychological alterations are major toxicities of anabolic steroids, and probably constitute the major mechanism of their action. Hepatic neoplasia occurs in the setting of abuse of this class of drugs, and may be related to their use, although there is no convincing evidence that other malignancies are induced in athletes who abuse them. Gross disturbance of reproductive function occurs in both sexes: hypogonadal states are common and prolonged. The anabolic steroids are toxic drugs with both long and short term effects. Their abuse by athletes is to be decried, particularly in view of the frequent and prolonged use by the young.

Testis cancer: post-natal hormonal factors, sexual behaviour and fertility

The relationship of risk of testis cancer, and subdivisions of the tumour by histology, to variables which may be related to hormonal status, sexual behaviour and fertility was investigated in data from a case-control study with 259 cases and 2 sets of controls. No consistent association was found between testis cancer risk and age at puberty, need to shave, obesity, alcohol intake, animal fat intake, and sexual behaviour. There was a significant excess of seminomas in very tall men. Testis cancer cases showed lower fertility than controls according to various measures, but this reflected the greater frequency of cryptorchidism among cases compared to controls. Among non-cryptorchid subjects there was no clear evidence that infertility was associated with risk of testis cancer.

Hormone profiles in Klinefelter's syndrome with and without testicular epidermoid cyst

Hormonal studies were performed in patients of Klinefelter's syndrome with and without testicular epidermoid cyst. Mean levels of plasma gonadotropins were elevated above normal ranges. The mean testosterone level in plasma was abnormally low. The mean prolactin level in plasma was within the normal limit. However, mean plasma levels of these hormones were not significantly different between the two groups. The administration of LH-RH resulted in low response of plasma gonadotropins. The response of plasma testosterone to the administration of hCG was also abnormally low. However, in the LH-RH and hCG tests there were no significant differences between the two groups. These data suggested that the hormonal disturbance in Klinefelter's syndrome is unrelated to the occurrence of testicular epidermoid cyst.

Synchronous bilateral primary germ cell tumors in patient receiving estrogen therapy

The present report concerns the occurrence of bilateral synchronous germ cell tumors in a sixty-eight-year-old man who received estrogen therapy for eleven months. Although there are previous reports on Leydig cell tumors developing in mice and man receiving estrogens, we have not found any connection between germ cell tumors and estrogen medication reported in the literature.

Hematologic malignancy in sickle cell disease: report of four cases and review of the literature

Hematologic malignancy has rarely been reported in adults with sickle cell disease. We describe four sickle cell patients (two with hemoglobin SC, two with hemoglobin SS) who developed hematologic malignancy (acute myeloblastic leukemia, multiple myeloma, malignant histiocytosis, and Hodgkin's disease). Three of the cases represent the first adult association between SC or SS hemoglobinopathy and the particular malignancy involved. Sickle hemoglobin does not appear to exert a protective effect against childhood hematologic malignancies, suggesting that better survival in sickle cell disease may be accompanied by an increased incidence of hematologic neoplasms in adulthood. Karyotypic analysis revealed alterations of chromosome 5 in two sickle cell patients with leukemia, raising the possibility of a chromosomal link between the two diseases. Further epidemiologic and cytogenetic studies are needed to define the relationship between hematologic malignancy and sickle cell disease.

Testicular tumors in subfertile men: report of 4 cases with implications for management of patients presenting with infertility

We report on 4 men attending our infertility clinic in whom seminomas developed. A review of testicular biopsies performed for investigation of subfertility in 2 patients revealed in situ and early invasive carcinoma. Infertile men have a prevalence of carcinoma in situ in the range of 1 per 100 to 200, with a high risk of progression to invasive germ cell tumor (50 per cent within 5 years of diagnosis). Biopsy is the only method of detection of the in situ lesion and, therefore, is recommended in the investigation of oligospermic and azoospermic male subjects. The surgical approach to and diagnostic sensitivity of testicular biopsy are reviewed, and the management of carcinoma in situ is discussed.

Carcinoma in situ in testicular biopsies from men presenting with infertility

This study concerns 2043 male partners of infertile marriages who underwent testicular biopsy in the 28 years from 1955 to 1982. In a review of the pathological material carcinoma in situ (CIS) was diagnosed in 8 men (0.39%). Six of these men were later found to have invasive germ cell tumours; one has remained tumour-free and one is lost to follow-up. The implication of these findings in relation to the selection of patients for biopsy and the treatment of CIS when diagnosed is discussed.